Purpose
Virtually all counseling settings will have clients who have survived trauma, leaving mental health professionals coping with the emotional exposure of clients' traumatic stories. McCann and Pearlman (1990) defined the term vicarious trauma (VT) as the transformation experienced within the counselor from the empathic engagement of listening to client traumatic content during counseling sessions. VT includes cognitive shifts, altered belief systems, and negative emotional responses within the mental health professional, which can be cumulative over time (Pearlman & MacIan, 1995). Diverse individual, social, community, and organizational factors may impact the degree of individual vulnerability in the development of VT (Pulido, 2012).
In reviewing existing literature, no data was found demonstrating a correlation between differentiation of self (DoS) and VT. DoS has been described as the ability to maintain rational thought in the midst of emotionally charged situations (Bowen, 1978). In conducting this research project, I sought to determine if the level of subcomponents in DoS including emotional reactivity (ER), I position (IP), emotional cutoff (EC), and fusion with others (FO) predict the level of VT in mental health professionals. Through identification of additional predictors of VT, the long term emotional health of mental health professionals may be preserved through early identification, education, and prevention of VT to better serve the mental health needs of clients on a global level (Michalopoulos & Aparicio, 2012).
In this research project, I evaluated four research questions using multiple regression analysis with the forward entry method. A fifth question was evaluated through backwards linear regression. In Chapter 4, I reviewed the statistical analysis and results. In this chapter, I have provided interpretations of my results. Additionally, I discuss and review the limitations of the study, future research and action
recommendations, and implications for positive social change in the counseling field. Interpretation of Findings
In this section, I interpret the findings in this study in relation to the theoretical lens for the study. I then interpret the study findings for each of the five research questions based on my review of the literature.
Theoretical Foundation
The theoretical foundation of this study is Bowen’s family systems theory. The theory focused on goals to increase the level of DoS and subcomponents of DoS by increasing counseling trainees' awareness of their emotions within the context of the family of origin. Bowen (1978) theorized that trainees with an increased awareness of emotional patterns in the family of origin would become more effective counselors when compared to trainees who are less aware. The intergenerational relationship patterns developed within the family of origin are believed to be the initial interaction pattern with authority figures, intimate relationships, and clients (Bowen, 1978). Drake et al. (2015) noted how DoS serves as the balance between togetherness and individuality in
Kerr and Bowen (1988) noted that at any point a person may be stressed to the degree that symptoms of physical, social, or emotional symptoms of stress may appear. However, Drake et al. (2015) described how more stress may be required to trigger a symptom in an individual with a higher score on the DoS. Individuals scoring high on DoS can be more resilient against the effects of stressors where individuals while lower scores on DoS may symbolize significant psychological distress under the same stressors, according to Murdock and Gore (2004). Individuals with higher levels of DoS would be able to actively utilize objective coping skills rather than avoidance or emotionally fueled responses (Murdock & Gore, 2004).
While an individual with higher levels of DoS may be comfortable in situations with strong emotional content, a less differentiated person may become emotionally overwhelmed leading to higher levels of psychological distress (Skowron & Friedlander, 1998). Researchers (Jenkins et al., 2005; Johnson et al., 2014; Skowron & Friedlander, 1998; Skowron et al., 2004; Skowron et al., 2009) developed data supporting higher levels of psychological distress existed in relation to lower levels of DoS. Therefore, through the lens of Bowen’s theory, it is theorized that the mental health professional with higher levels of DoS would be able to maintain more emotional autonomy within the context of client relationships. This more objective and emotionally autonomous stance may decrease how vulnerable the mental health professional will be in developing VT (Pulido, 2012).
Within the context of Bowen’s theory, individuals with lower levels of DoS may be more vulnerable to develop VT because they are more likely have dysfunctional
psychological responses due to (a) a lower ability to maintain IP, (b) higher ER, (c) higher EC, and (d) higher FO. Symptoms of VT include negative emotional reactions leaving it difficult to for the clinician to provide an empathic response in client sessions, , an altered belief system, and negative psychological consequences such as irritability or mood disturbances from providing a compassionate and empathic response within counseling sessions (McCann & Pearlman, 1990). More highly differentiated individuals defined as those with (a) lower ER, (b) stronger IP, (c) lower EC, and (d) lower FO are considered to be more adaptive and flexible when under stress. This suggests that they are more capable of mediating emotional distress imposed on them during stressful events (Skowron et al., 2004). Individuals with higher levels of DoS are less likely to react in a dysfunctional manner under stress and will recover more rapidly from stressful events (Friedman, 1991) possibly leaving them at a lower risk of developing VT. Mental health professionals with higher levels of DoS may experience less VT because they are better able to remain more rational, less anxious, and more self-aware in the context of counseling sessions.
The results of this study provided insight and empirical data supporting DoS and subcomponents of DoS predicting VT in a group of licensed or certified mental health professionals in Midwest community counseling agencies. In this respect, the study findings confirmed prior research that the higher the level of DoS, the lower the negative psychological effects (Kerr & Bowen, 1988; Pelog & Arnon, 2013; Skowron et al., 2009). VT, including difficult emotional symptoms, negative psychological
Jordan, 2010, McCann & Pearlman, 1990), were predicted from the subcomponent scores of DoS in this study. The subcomponent scores of DoS had an inverse relationship with VT. The next section will provide more specific detail on the individual results from data collection and literature review of each research question. Additionally, the best
predictors of VT will be reviewed.
Discussion of Findings for Research Question 1
In this study, a significant regression equation was found indicating that lower scores on the ER subscale predicts VT in that participants with lower scores on the ER subscale had more VT. Lower scores on the Differentiation of Self Inventory-Revised (DSI-R) ER subscale indicate lower DoS (Skowron & Schmitt, 2003). The negative correlation of r = -.505 between ER and VT resulted in a large magnitude between the variables (see Cohen, 1988).
ER has been deemed to be the central barometer of DoS and the individual's ability to separate feelings and thinking (Bowen, 1978). Bowen (1978) and Skowron and Schmitt (2003) noted how the degree of ER supports self-regulation of emotions.
Additionally, Bowen (1978), as cited by Skowron and Dendy (2004), noted how lower levels of ER enabled participants in their study of adult relationships to self-soothe during periods of anxiety and continue to remain engaged in the relationships under study. Therefore, the ability to examine thoughts logically and have a full awareness of emotional states would support the data collected in this study. Lower scores on the ER subscale correlated with a lower DoS, leading to higher VT scores in mental health professionals.
As reviewed in chapter two, Skowron et al. (2009) found that lower levels of ER early in the semester for college students was predictive of less psychological distress later in the semester. The higher the DoS, the more likely the individual will be able to regulate the degree of emotion towards others and will experience lower levels of anxiety. This more differentiated individual or less emotionally reactive person would then be emotionally capable of making objective decisions and would have clearer boundaries (Parsons, Nalbone, Killmer, & Wetchler, 2007) resulting in less VT (Michalopoulos & Aparicio, 2012).
The ability to articulate emotions in a reflective manner representative of lower levels of anxiety relates to an individual’s degree of ER (Bowen, 1978). Skowron et al. (2009) reported participants with higher degrees of ER tended to have more irritability, less concern for others' welfare, and difficulty regulating emotions under stress. In this respect, the findings in this study confirmed existing research noting higher ER or lower DoS as predictive of negative symptomology. Symptoms of high ER are similar to the symptoms of VT. VT symptoms can mimic high levels of ER or low DoS because the symptoms can include anxiety, irritability, poor emotional regulation, altered belief systems, and struggles with personal identity (Howlett & Collins, 2014; Pearlmann & Saakvitne, 1995).
The literature summarized in regards to ER and the results of my study support the concept that mental health professionals who have more VT have higher levels of ER. Results confirmed that a lower ER predicts fewer psychological and interpersonal
DSI-R ER subscale indicates lower DoS and was predictive of higher levels of VT on the VTS.
Discussion of Findings for Research Question 2
In this study, a significant regression equation was found indicating IP predicted VT in that participants with lower scores on the IP subscale had more VT. Lower scores on the DSI-R IP subscale indicated lower DoS (Skowron & Schmitt, 2003). The negative correlation of r = -.422 between IP and VT resulted in a moderate magnitude between the variables (see Cohen, 1988).
By maintaining a stronger IP as a clinician, this sets an example of stronger differentiation of self for clients in session, maintains a neutral stance in therapy, and reduces the degree of anxiety in the therapy process (Hanson, 2009). Mental health professionals’ ability to have a stronger DoS frees them to focus on the counseling theory in sessions versus being distracted by trying to manage the emotions of the client
(Hanson, 2009). The more independent stance created by higher DoS (Brown, 1999; Hanson, 2009; Kerr & Bowen, 1988) leads to clearer emotional boundaries between the mental health practitioner and client, resulting in lower levels of VT (Pearlman & MacIan, 1995).
Skowron and Friedlander (1998) noted how a stronger IP promoted lower anxiety, stronger psychological adjustment, and better marital satisfaction. Bartle-Haring, Glade, and Vira (2005) supported Bowen's theory that higher levels of DoS are reflective of higher levels of overall emotional health and functioning within relationships due to a healthier IP. The results of Bartle-Haring et al. (2005) and my study are reflective of both
Bowen's theory and previous research which found that higher levels of DoS lead to better emotional outcomes, and therefore, less VT.
Higher levels of IP were found to be predictive of stronger levels of career identity (Johnson et al., 2014). Johnson et al. (2014) suggested the individual's ability to have a clearly defined identity and follow one's personal convictions even when
pressured to do otherwise is predictive of successful career development. Individuals with higher levels of IP have a stronger capacity and emotional reserve to be goal directed specifically to their career development (Johnson et al., 2014). Skowron et al. (2009) identified how young adults who are better able to take on an independent stance or stronger IP in relationships developed fewer interpersonal problems over the course of their longitudinal study. Skowron et al. (2009) supported the idea that healthy emotional contact and a solid sense of self, or IP, leads to healthy emotional development thru adulthood.
The literature summarized in regards to IP and the results of my study support mental health professionals having less VT when maintaining a stronger sense of IP or self-directed behavior. The results of my study confirmed previous findings that a stronger IP predicts fewer psychological and interpersonal problems. In the case of my study, lower scores on the DSI-R IP subscale predicted lower DoS and predicted higher levels of VT on the VTS.
Discussion of Findings for Research Question 3
In this study, a significant regression equation was found indicating EC predicts VT in that participants with lower scores on the EC subscale had more VT. Lower scores
on the DSI-R EC subscale predicted lower differentiation of self (Skowron & Schmitt, 2003). The negative correlation of r = -.239 between EC and VT resulted in a small magnitude between the variables (see Cohen, 1988).
Skowron et al. (2009) found a sense of anxiety was linked to EC and attempts to create distance in relationships as a means to manage the anxiety. Skowron et al. (2009) noted IP in addition to EC had unique contributions to emotional well-being in young adults. In their study, the adults identified in the beginning of the college semester as having higher degrees of EC had more interpersonal and psychological problems when compared over time to peers with higher levels of DoS. The researchers noted how the young adults who began the semester with a lower sense of IP seemed more likely to emotionally cut off in an attempt to define a sense of self. Participants with higher levels of FO, ER, and EC developed more complex or difficult issues in interpersonal
relationships over time. Individuals who tended to be more emotionally cut off seemed more likely to try to control others in relationships as if to remain aloof or distant (Skowron et al., 2009).
Johnson et al. (2014) described the importance of clinicians being clear about the qualitative differences between EC and healthy levels of DoS. Often, the level of ER associated with separation in relationships can be the key distinction in healthy levels of DoS or degree of EC (Johnson et al., 2014). Mental health professionals with high levels of EC may be trying to self-protect or maintain emotionally distance in the stressful context of counseling sessions which leads to VT . For example, mental health
avoid client contact (Bride, Hatcher, & Humble, 2009; Figley 1995) as a means of EC. The results in my study lend support to the idea that mental health professionals with higher degrees of EC or lower DoS have higher scores of VT.
As noted in research findings for question one, Bowen (1978) described both ER and EC as enabling self-soothing behaviors during periods of anxiety. Mental health professionals engaging in self-care or preventative measures to avoid negative
psychological symptoms (Howlett & Collins, 2014) would likely be demonstrating less ER and EC and be experiencing fewer symptoms of VT. The data in my study with 83 mental health professionals was consistent with lower levels of EC predicting less VT. Knerr and Bartle-Haring (2010) noted higher scores of DoS were predictive of relationship satisfaction in couples. It is noteworthy that EC scores were significantly predictive of changes in the degree of relationship satisfaction over time. Knerr and Bartle-Haring (2010) found data supporting husbands with lower EC scores were more likely to have a higher degree of relationship satisfaction. The higher the level of DoS the less likely the person will use EC as a means to create distance and lower anxiety within the relationship (Kerr & Bowen, 1988). The level of EC appears to have some
predictability in the outcomes of emotional health in relationships. The results of my study lend support to EC scores as possible predictor variables in the context of relationships.
The literature in regards to EC and the results of my study support that mental health professionals who have higher levels of VT also have higher levels of EC or lower DoS. The results of my study confirmed previous findings that lower levels of EC predict
fewer psychological and interpersonal problems and higher DoS. In the case of my study, the lower the score on the DSI-R EC subscale predicted lower DoS and higher levels of VT on the VTS.
Discussion of Findings for Research Question 4
In this study, a significant regression equation was found indicating FO predicts VT in that participants with lower scores on the FO subscale had more VT. Lower scores on the DSI-R FO subscale indicated lower DoS (Skowron & Schmitt, 2003). The
negative correlation of r = -.474 between FO and VT resulted in a moderate magnitude between the variables (see Cohen, 1988).
The degree of FO developed by the mental health professional impacts the degree of emotional closeness and boundaries in client relationships (Jankowski & Hooper, 2012; Kerr & Bowen, 1988). A positive therapeutic alliance can be characterized as having healthy supportive boundaries. Better relationships and emotional boundaries with family of origin results in higher degrees of DoS with lower FO (Kerr & Bowen, 1988). Johnson et al. (2014) described how FO can be characterized by being overly emotionally involved with parental relationships. FO with parents impacted participants' ability to make independent career decisions (Johnson et al., 2014; Larson & Wilson, 1998) and have positive relationship skills . Individuals with high levels of FO have a tendency to have a less stable belief system and may seek approval or acceptance from others as a primary goal versus making independent choices as a young adult (Johnson et al., 2014; Larson & Wilson, 1998).
Larson and Sivo (1998) found that counseling trainees with better relationships with their family of origin were more likely to develop a healthy therapeutic alliance with clients in counseling sessions. Poor relationships with parents in the family of origin could lead to problems maintaining appropriate levels of emotional closeness or FO (Bowen, 1978). Larson and Sivo (1998) reviewed how FO can impact the ability of the counselor to remain individuated in relationships with clients. Larson and Sivo (1998) studied counseling trainees in their first practicum experience to determine if the ability to develop healthy relationships outside of the family of origin impacted therapeutic alliance with clients. Trainees were divided into two groups. Clients had more favorable relationships with counseling trainees who were able to identify with their own children or had another significant relationship outside of the family of origin versus trainees that did not have a significant relationship (i.e., child or spouse) outside of the family of origin. (Larson & Sivo, 1998). Results from Larson and Sivo (1998) suggest that lower levels of FO, or higher DoS, led to mental health professionals having healthier
boundaries with clients. Lower levels of FO may prevent the clinician from being overly attached in the client relationship and lower levels of VT. Results of my study
demonstrate low FO, or higher DoS, predicted lower levels of VT.
Skowron et al. (2009) linked higher degrees of ER with a tendency to have more FO, which leads to boundary issues in relationships, difficulty being alone, and being more intrusive in relationships. Spencer and Brown (2007) also described common behavioral or emotional responses for individuals unable to maintain a strong DoS as characteristic of FO and EC. The degree to which an individual strongly complies with
the opinion of another person may reflect FO through their dependency on the other person (Spencer & Brown, 2007). Harrison and Westwood (2009) described how clear boundaries allow clinicians to remain empathetic to the client without confusing the